Hearing is critical for the development of speech and language and very important for social interaction. As Helen Keller stated, "deafness separates people from people."

The Team

Dr. John Dornhoffer* (pictured right with a patient) and the pediatric otolaryngologists at Arkansas Children¹s Hospital (ACH) are experts in the diagnosis and management of pediatric ear related problems. Dr. Dornhoffer is a graduate of the University of Kansas Medical School and completed a residency in otolaryngology at the University of Arkansas for Medical Sciences College of medicine. He completed a fellowship in otology and neurotology in Germany and Switzerland. Dr. Dornhoffer has been on the medical staff at ACH for more than 10 years. He is Director of the Cochlear Implant Program and has developed a program of providing comprehensive otology needs for the children of Arkansas.

Specialty nurses ­ The specialty nurses at ACH are critical for management of children with ear related problems. They are important for continuity of patient care, education of caregivers and families, and for development and dispensation for hospital therapy.

Audiologists ­ ACH has a highly skilled team of pediatric audiologists who are experts in the diagnosis and management of pediatric hearing loss. They provide comprehensive care including the latest hearing aid technology such as digital hearing aids and cochlear implants.

Speech therapists ­ ACH has speech therapists that provide diagnostic and therapeutic needs for children with hearing loss as well as a variety of other speech delays. ACH has two speech language pathologists certified in auditory/verbal therapy of only 300 worldwide.

Anesthesia ­ ACH has a team of highly trained pediatric anesthesiologists skilled in the special needs of providing anesthesia for critically ill infants and children.

The hospital ­ With state of the art equipment, including an operating suite devoted to ear surgery, ACH is an entire hospital dedicated to the care, love, and hope for children in Arkansas.

Types of Problems

Otology problems range from the very common ear infections (acute otitis media), to profound sensorineural hearing loss which may require cochlear implantation to related problems such as dizziness and vertigo. Ear related problems may be diagnosed at or shortly after birth and can be diagnosed and rehabilitated at virtually any age. Comprehensive diagnosis, medical management, and surgical intervention may be provided depending upon the problem.

Acute otitis media, or ear infections, occurs in at least 75% of children.
Most children are treated with antibiotics but occasionally children require myringotomy to diagnosis or treat an ear infection. Children with frequent ear infections may benefit from tube insertion.

Chronic otitis media with effusion is persistent fluid in the middle ear space for more than two to three months. This can result in hearing loss, damage to the eardrum, and speech and language delay. Occasionally, surgical intervention with tube placement is needed. Adenoidectomy also may be useful.

Sensorineural, or nerve deafness occurs in 2-4 of every 1,000 children born.
The diagnosis is oftentimes made shortly after birth by infant hearing screening programs. Comprehensive diagnostic testing is available through the ACH Audiology Department. Medical diagnosis is made by Dr. Dornhoffer¹s team of otologists and pediatric otolaryngologists. Intervention may include hearing aids, auditory trainers, or cochlear implantation for severe cases. Speech therapy, both diagnosis and treatment, is also available.

Conductive hearing loss may occur from middle ear effusion or from an inborn abnormality or acquired problem with the eardrum or middle ear bones. After diagnosis, patients can be rehabilitated with bone anchored hearing aids, a medically implanted device which optimizes hearing. Many patients can be improved with procedures Dr. Dornhoffer has pioneered.

Cholesteatoma is small skin cyst which grows in the middle ear. These masses can slowly expand and destroy ear bones or the inner ear system. They result in chronic infection and typically do not respond to medical management. Dr.Dornhoffer and the team typically perform a tympanomastoidectomy to remove the cyst and rebuild the hearing mechanism.

Dizziness, or vertigo, is uncommon in children and can be related to a variety of underlying problems including inner ear damage, small ear tumors, seizures, migraines, and a variety of other problems. Diagnosis is made by a variety of tests provided through the Arkansas Children¹s Hospital team.
Medical management includes dizziness in the vast majority of patients, while rare patients undergo surgery.

Diagnostic Tools

Audiograms can be performed by pediatric otolaryngologists to reliably diagnose hearing in young children through adults. This test is designed to be fun and interactive for children while providing accurate diagnostic information.

Otoacoustic emissions, or OAEs, is a very quick screening method to determine whether the cochlea, or organ of hearing, is functioning appropriately. This can help determine whether infants have normal hearing.

Audiotory brainstem response, or ABR, measures brainwave response to sound.
This test is done under light sedation and can provide an excellent representation of hearing in young children or uncooperative patients.

Tympanogram is a test which measures whether fluid is present behind the eardrum by placing a simple probe in the ear.

Tympanostomy with tube insertion (PET) is a minor surgery often performed with patients asleep in the operating room, where a small tube is inserted directly through the eardrum to remove middle ear fluid. This is most commonly performed for recurrent infections or persistent middle ear fluid.

Tympanoplasty is a delicate procedure performed to repair holes in eardrums and to repair or revise the middle ear bones. This can be done through an incision either through the ear canal or behind the ear.

Mastoidectomy is a surgery performed by drilling behind the ear in which the infected bone, the mastoid bone, behind the ear is opened up to remove infected tissue or cholesteatoma. This is often done in conjunction with a tympanoplasty to repair the eardrum and ear bones.

For the cochlear implantation procedure, a small wire is inserted through the mastoid directly into the cochlea. This is connected with a small implant buried directly under the skin. This allows soundwaves to be converted directly to electrical energy to stimulate the cochlea.

A bone anchored hearing aid is a surgically implanted device in which a small screw is placed directly into the skull. The attached hearing device then directly stimulates the skull and cochlea resulting in improvement in hearing.

Contact Info/Referrals
ENT Clinic: 501-364-1225
ENT Office: 501-364-1047

*Dr. John Dornhoffer, director otology/neurotology, ACH professor, UAMS.